Hormonal responses to exercise after partial sleep deprivation and after a hypnotic drug-induced sleep

Sleep architecture of elite soccer players surrounding match days as measured by WHOOP straps

This study aimed to quantify and compare sleep architecture before and after home and away matches in elite soccer players from the English Premier League. Across two seasons, 6 male players (age 28 ± 5 y; body mass 85.1 ± 9.5 kg; height 1.86 ± 0.09 m) wore WHOOP straps to monitor sleep across 13 matches that kicked off before 17:00 h. For each, sleep was recorded the night before (MD-1), after (MD) and following the match (MD +1). Across these 3 days total sleep time (TST), sleep efficiency (SE), sleep disturbances, wake time, light sleep, deep sleep, REM sleep, sleep and wake onsets, alongside external load, were compared. TST was reduced after MD versus MD +1 (392.9 ± 76.4 vs 459.1 ± 66.7 min, p = 0.003) but no differences existed in any other sleep variables between days (p > 0.05). TST did not differ after home (386.9 ± 75.7 min) vs. away matches (401.0 ± 78.3 min) (p = 0.475), nor did other sleep variables (p > 0.05). GPS-derived external load peaked on MD (p < 0.05). In conclusion, despite reduced TST on MD, sleep architecture was unaffected after matches played before 17:00 h, suggesting sleep quality was not significantly compromised.

Sleep and Sport Performance

SUMMARY

Elite athletes and coaches believe sleep is the most important recovery strategy and widely consider it critical to optimal performance. Despite this perceived importance, there are numerous circumstances that can reduce sleep quantity and quality in athletic populations. Because of the effects of sleep loss on various physical, neurophysiological, and cognitive parameters, such perturbations can have consequences for performance and recovery outcomes. Although peer-reviewed literature examining the interaction between sleep, performance, and recovery in athletes is increasing, understanding of these issues remains equivocal. Perhaps most pertinently, the effect of sleep on sport performance does not align with a one-size-fits-all approach and rather depends on numerous factors such as type of sport, scheduling, time of the season, and the intraindividual requirements for sleep. The relationship between brain plasticity and memory, which in turn can influence learning processes and long-term memory consolidation, suggests that sleep may play an important role in learning new skills and tactics for both elite and developing athletes. The aim of this special issue review was to analyze the evidence of sleep loss on sport performance and recovery, with a specific focus on elite athletes. An assessment of these sleep-compromising situations that elite athletes may face during a typical season and practical considerations for alleviating these issues is also provided to further the understanding for medical professionals, scientists, and applied sporting practitioners alike.

Effect of sleep disturbance on biomarkers related to the development of adverse health outcomes: A systematic review of the human literature

Literature suggests that unrestricted and undisturbed sleep is vital for basic human function and performance; however, it is unclear as to what amount of sleep disturbance leads to dysregulation in biomarkers, which may underscore the development of adverse health effects. This systematic review aims to identify the amount of sleep disturbance that contributes to biomarker changes as a potential precursor to the development of adverse health effects. English-language comparative studies available in PubMed, Cochrane Central, EMBASE, and CINAHL databases from 1 January 1980 to 31 July 2021 were searched. Where possible, random-effects meta-analyses were used to examine the effect of sleep disturbances on adverse health effects. The risk of bias of individual studies was assessed using the Cochrane Risk of Bias Tool and the Risk of Bias of Nonrandomised Studies - of Exposures instruments and the certainty of the body of evidence for each outcome was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. The search identified 92 primary studies reporting on blood pressure, hypertension, heart rate, cardiac arrhythmia, cardiac output, waist circumference, cortisol, adrenaline, noradrenaline, immune system markers, glucose, insulin, cholesterol, and triglyceride levels. Although some meta-analyses suggested there may be an association between sleep disturbances and certain outcomes, the certainty in the evidence was very low due to concerns with risk of bias, inconsistency across exposures, populations, and imprecision in the estimates of effects. Further research is needed to explore the point at which types, levels and duration of sleep disturbances may begin to increase the risk of developing adverse health outcomes to inform and tailor health interventions.

Effects of Acute Sleep Loss on Physical Performance: A Systematic and Meta-Analytical Review

BACKGROUND

Sleep loss may influence subsequent physical performance. Quantifying the impact of sleep loss on physical performance is critical for individuals involved in athletic pursuits.

DESIGN

Systematic review and meta-analysis.

SEARCH AND INCLUSION

Studies were identified via the Web of Science, Scopus, and PsycINFO online databases. Investigations measuring exercise performance under 'control' (i.e., normal sleep, > 6 h in any 24 h period) and 'intervention' (i.e., sleep loss, ≤ 6 h sleep in any 24 h period) conditions were included. Performance tasks were classified into different exercise categories (anaerobic power, speed/power endurance, high-intensity interval exercise (HIIE), strength, endurance, strength-endurance, and skill). Multi-level random-effects meta-analyses and meta-regression analyses were conducted, including subgroup analyses to explore the influence of sleep-loss protocol (e.g., deprivation, restriction, early [delayed sleep onset] and late restriction [earlier than normal waking]), time of day the exercise task was performed (AM vs. PM) and body limb strength (upper vs. lower body).

RESULTS

Overall, 227 outcome measures (anaerobic power: n = 58; speed/power endurance: n = 32; HIIE: n = 27; strength: n = 66; endurance: n = 22; strength-endurance: n = 9; skill: n = 13) derived from 69 publications were included. Results indicated a negative impact of sleep loss on the percentage change (%Δ) in exercise performance (n = 959 [89%] male; mean %Δ =  - 7.56%, 95% CI - 11.9 to - 3.13, p = 0.001, I2 = 98.1%). Effects were significant for all exercise categories. Subgroup analyses indicated that the pattern of sleep loss (i.e., deprivation, early and late restriction) preceding exercise is an important factor, with consistent negative effects only observed with deprivation and late-restriction protocols. A significant positive relationship was observed between time awake prior to the exercise task and %Δ in performance for both deprivation and late-restriction protocols (~ 0.4% decrease for every hour awake prior to exercise). The negative effects of sleep loss on different exercise tasks performed in the PM were consistent, while tasks performed in the AM were largely unaffected.

CONCLUSIONS

Sleep loss appears to have a negative impact on exercise performance. If sleep loss is anticipated and unavoidable, individuals should avoid situations that lead to experiencing deprivation or late restriction, and prioritise morning exercise in an effort to maintain performance.

Sleep and Athletic Performance: Impacts on Physical Performance, Mental Performance, Injury Risk and Recovery, and Mental Health: An Update

Sleep health is an important consideration for athletic performance. Athletes are at high risk of insufficient sleep duration, poor sleep quality, daytime sleepiness and fatigue, suboptimal sleep schedules, irregular sleep schedules, and sleep and circadian disorders. These issues likely have an impact on athletic performance via several domains. Sleep loss and/or poor sleep quality can impair muscular strength, speed, and other aspects of physical performance. Sleep issues can also increase risk of concussions and other injuries and impair recovery after injury. Cognitive performance is also impacted in several domains, including vigilance, learning and memory, decision making, and creativity.

Sleep Duration Correlates With Performance in Ultra-Endurance Triathlon

The relationship between sleep duration, sleep quality, and race completion time during each stage of a 3-day ultra-endurance triathlon (stage 1: 10-km swim, 146-km cycle; stage 2: 276-km cycle; and stage 3: 84.4-km run) was investigated. Seventeen triathletes partook in sleep analysis throughout the ultra-endurance multiday triathlon using an actigraphy wristband. The participants wore the band to record objective sleep outcomes for approximately 4 days (1-2 d prerace, 3 race days, and 1 d postrace), except while racing. The total sleep time (TST; prerace: 414.1 [95.3] min, prestage 1: 392.2 [138.3] min, prestage 2: 355.6 [62.5] min, and prestage 3: 299.7 [107.0] min) significantly decreased over time (P < .05). Significant Pearson moment-product correlations were found between TST and subsequent race-day performance for race stage 1 (r = -.577; P = .019) and stage 3 (r = -.546; P = .035), with further analysis revealing that TST explained 33% and 30% of the variation in performance for stages 1 and 3, respectively. During a 3-day ultra-endurance triathlon, the TST was reduced and had a significant negative correlation to exercise performance, indicating that sleep loss was associated with slower performances. Sleep onset latency, wake episodes, and sleep efficiency did not significantly change over the course of this investigation, which may stem from the close proximity of exercise to sleep.

High-Intensity Interval Exercise Performance and Short-Term Metabolic Responses to Overnight-Fasted Acute-Partial Sleep Deprivation

People practicing high-intensity interval exercise (HIIE) fasted during the morning hours under a lack of sleep. Such a habit may jeopardize the health benefits related to HIIE and adequate sleep. Fifteen habitually good sleeper males (age 31.1 ± 5.3 SD year) completed on a treadmill two isocaloric (500 kcal) HIIE sessions (3:2 min work:rest) averaged at 70% VO2reserve after 9-9.5 h of reference sleep exercise (RSE) and after 3-3.5 h of acute-partial sleep deprivation exercise (SSE). Diet and sleep patterns were controlled both 1 week prior and 2 days leading up to RSE and SSE. HIIE related performance and substrate utilization data were obtained from the continuous analysis of respiratory gases. Data were analyzed using repeated measures ANOVA with the baseline maximum oxygen uptake (VO2max) and body fat percentage (BF%) as covariates at p < 0.05. No difference was observed in VO2max, time to complete the HIIE, VE, RER, CHO%, and FAT% utilization during the experimental conditions. Whether attaining an adequate amount of sleep or not, the fasted HIIE performance and metabolism were not affected. We propose to practice the fasted HIIE under adequate sleep to receive the pleiotropic beneficial effects of sleep to the human body.

Effects of partial sleep deprivation after prolonged exercise on metabolic responses and exercise performance on the following day

PURPOSE

We determined the effect of partial sleep deprivation (PSD) after an exercise session on exercise performance on the following morning.

METHODS

Eleven male athletes performed either a normal sleep trial (CON) or a PSD trial. On the first day (day 1), all subjects performed an exercise session consisting of 90 min of running (at 75% V̇O2max) followed by 100 drop jumps. Maximal strength (MVC) was evaluated before and after exercise. In the CON trial, the sleep duration was 23:00-7:00, while in the PSD trial, the sleep duration was shortened to 40% of the regular sleep duration. On the following morning (day 2), MVC, the metabolic responses during 20 min of running (at 75% V̇O2max), and time to exhaustion (TTE) at 85% V̇O2max were evaluated.

RESULTS

On day 2, neither the MVC nor V̇O2 during 20 min of running differed significantly between the two trials. However, the respiratory exchange ratio was significantly lower in the PSD trial than in the CON trial (p = 0.01). Moreover, the TTE was significantly shorter in the PSD trial than in the CON trial (p = 0.01).

CONCLUSION

A single night of PSD after an exercise session significantly decreased endurance performance without significantly changing muscle strength or cardiopulmonary response.

Caffeine Use or Napping to Enhance Repeated Sprint Performance After Partial Sleep Deprivation: Why Not Both?

PURPOSE

To compare the effect of a 20-minute nap opportunity (N20), a moderate dose of caffeine (CAF; 5 mg·kg-1), or a moderate dose of caffeine before N20 (CAF+N) as possible countermeasures to the decreased performance and the partial sleep deprivation-induced muscle damage.

METHODS

Nine male, highly trained judokas were randomly assigned to either baseline normal sleep night, placebo, N20, CAF, or CAF+N. Test sessions included the running-based anaerobic sprint test, from which the maximum (Pmax), mean (Pmean), and minimum (Pmin) powers were calculated. Biomarkers of muscle, hepatic, and cardiac damage and of enzymatic and nonenzymatic antioxidants were measured at rest and after the exercise.

RESULTS

N20 increased Pmax compared with placebo (P < .01, d = 0.75). CAF+N increased Pmax (P < .001, d = 1.5; d = 0.94), Pmin (P < .001, d = 2.79; d = 2.6), and Pmean (P < .001, d = 1.93; d = 1.79) compared with placebo and CAF, respectively. Postexercise creatine kinase increased whenever caffeine was added, that is, after CAF (P < .001, d = 1.19) and CAF+N (P < .001, d = 1.36). Postexercise uric acid increased whenever participants napped, that is, after N20 (P < .001, d = 2.19) and CAF+N (P < .001, d = 2.50) and decreased after CAF (P < .001, d = 2.96).

CONCLUSION

Napping improved repeated-sprint performance and antioxidant defense after partial sleep deprivation. Contrarily, caffeine increased muscle damage without improving performance. For sleep-deprived athletes, caffeine before a short nap opportunity would be more beneficial for repeated sprint performance than each treatment alone.

Partial sleep deprivation affects endurance performance and psychophysiological responses during 12-minute self-paced running exercise

PURPOSE

This study aimed to investigate the effects of partial sleep deprivation (PSD) on physical performance and psychophysiological responses during 12-minute self-paced running exercise.

METHODS

Twenty runners (20.8±1.1 years, 70.6±4.9 kg, 175.1±3.9 cm) performed, in a randomized order, two running self-paced field exercises after a normal sleep night (CONT, bedtime from 22:30 h to 06:30 h) and one night of PSD (bedtime from 00:30 h to 04:30 h). Core temperature and motivation were recorded before exercise. Speed, covered distance, heart rate (HR), rating of perceived exertion (RPE) and respiratory parameters (i.e., minute ventilation (VE), oxygen uptake (VO₂) and carbon dioxide production (VCO₂)) were assessed during exercise. Blood lactate concentration [La] was assessed 2 min after exercise. Simple reaction time (SRT), mood and barrage test (BT) were assessed before and after exercise.

RESULTS

Higher RPE (p=0.01, d=0.90) and lower physical performance (i.e., p=0.001, d=0.59 for running speed and p=0.01, d=0.7 and Δ (%)=-6% for covered distance), following PSD, were obtained compared to CONT. Similarly, PSD attenuated core temperature (p=0.01, d=0.84), HR (p=0.006, ɳp²=0.45), VE (p=0.001, ɳp²=0.73), VO₂ (p=0.001, ɳp²=0.96), BT (p<0.0005, ɳp²=0.86), SRT (p=0.0009, ɳp²=0.44) and mood (p<0.0005). However, VCO₂, [La] and motivation score were not affected by sleep conditions.

CONCLUSION

The decrease of running performance and the increase of physical discomfort after PSD could be the origin of the lower cardio-respiratory responses to the 12-minute self-paced exercise. Effective strategies should be introduced to overcome the deterioration of physical performance and physiological responses after PSD.

A critical review on sleep assessment methodologies in athletic populations: factors to be considered

A growing body of research focus on athletes' sleep in order to investigate the effects of sleep in sports performance and recovery or the prevalence of sleep disorders in athletes. At the same time, several sleep monitoring tools have been developed and used in athletic populations for fulfilling these purposes. This review aimed to provide critical assessment to the most used by athletes' methodological approaches and compared them with the gold standard approach. Advantages and disadvantages of the various sleep monitoring tools were critically discussed. Literature related to aspects of athletes' sleep was reviewed. From the shortlisted studies, several factors that seem to affect sleep in athletes were identified using objective methods such as polysomnography/electroencephalography and actigraphy. These factors were associated to sleep (eg such as sleep environment, familiarization procedures and napping) and daily habits (eg nutrition, fluid consumption, alcohol and caffeine intake, tobacco use). The selected studies that evaluated sleep objectively were screened according the reporting rates of these variables. The majority of the screened studies were found to underreport these variables. Practical issues were addressed and recommendations about reporting sleep-related factors were made in order to improve studies' quality assessment and allow for more robust comparisons between studies.

Effects of a 30 min nap opportunity on cognitive and short-duration high-intensity performances and mood states after a partial sleep deprivation night

This study evaluated the effects of partial-sleep-deprivation (SDN) and a 30 min nap opportunity on physical and cognitive performances and mood states. Fourteen physically active students (BMI = 232.8 ± 0.4 kg/m²) performed the reaction time, the number cancellation (i.e., assessing vigilance) and the 5-m shuttle run tests and responded to the Profile of Mood States (POMS-f) questionnaire at 18h00 after a normal-sleep (NSN) and a SDN) and after two nap conditions (Nap and no-Nap) realized between 13h00 and 13h30. Vigilance and the reaction time were better after Nap compared to no-Nap opportunity following NSN and SDN and during NSN compared to SDN only during no-Nap. Total and peak distance during the 5-m shuttle run test were higher and the fatigue index was lower during Nap compared to no-Nap condition after NSN and SDN and during NSN compared to SDN during Nap and no-Nnap. Anxiety, fatigue, confusion, and depression were lower and vigour was higher during Nap compared to no-Nap after NSN and SDN and during NSN compared to SDN during Nap and no-Nap. In conclusion, a 30-min of nap opportunity helps to overcome the negative effect of SDN on mood states as well as physical and cognitive performances.

Extended Sleep Maintains Endurance Performance Better than Normal or Restricted Sleep

PURPOSE

The cumulative influence of sleep time on endurance performance remains unclear. This study examined the effects of three consecutive nights of both sleep extension (SE) and sleep restriction (SR) on endurance cycling performance.

METHODS

Endurance cyclists/triathletes (n = 9) completed a counterbalanced crossover experiment with three conditions: SR, normal sleep (NS), and SE. Each condition comprised seven days/nights of data collection (-2, -1, D1, D2, D3, D4, and +1). Sleep was monitored using actigraphy throughout. Participants completed testing sessions on days D1-D4 that included an endurance time-trial (TT), mood, and psychomotor vigilance assessment. Perceived exertion (RPE) was monitored throughout each TT. Participants slept habitually before D1; however, time in bed was reduced by 30% (SR), remained normal (NS), or extended by 30% (SE) on nights D1, D2, and D3. Data were analyzed using generalized estimating equations.

RESULTS

On nights D1, D2, and D3, total sleep time was longer (P < 0.001) in the SE condition (8.6 ± 1.0, 8.3 ± 0.6, and 8.2 ± 0.6 h, respectively) and shorter (P < 0.001) in the SR condition (4.7 ± 0.8, 4.8 ± 0.8, and 4.9 ± 0.4 h) compared with NS (7.1 ± 0.8, 6.5 ± 1.0, and 6.9 ± 0.7 h). Compared with NS, TT performance was slower (P < 0.02) on D3 of SR (58.8 ± 2.5 vs 60.4 ± 3.7 min) and faster (P < 0.02) on D4 of SE (58.7 ± 3.4 vs 56.8 ± 3.1 min). RPE was not different between or within conditions. Compared with NS, mood disturbance was higher, and psychomotor vigilance impaired, after SR. Compared with NS, psychomotor vigilance improved after SE.

CONCLUSION

Sleep extension for three nights led to better maintenance of endurance performance compared with normal and restricted sleep. Sleep restriction impaired performance. Cumulative sleep time affects performance by altering the perceived exertion of a given exercise intensity. Endurance athletes should sleep >8 h per night to optimize performance.

Sleep debt induces skeletal muscle injuries in athletes: A promising hypothesis

Sleep is a physiological state and it is fundamental for physical and cognitive recovery of athletes. Due to strenuous training and competitions, athletes may present sleep complaints compromising good quality and quantity of sleep. Studies have related sleep debt to the occurrence of musculoskeletal injuries in athletes, but the mechanisms that can lead to this are not entirely clear. Studies involving animals and humans have shown that poor sleep quality can cause significant changes in hormones and cytokines. Demonstrating that this hormones changes lead to a decrease of testosterone and growth hormone levels and increased cortisol levels, important hormones in the process of protein synthesis and degradation. In athletes, the sport itself is a risk factor of injuries, and sleep debt may result in overtraining syndrome associated with inflammatory markers and ultimately to immune system dysfunction. Thus, we hypothesize that athletes who have sleep debt are more susceptible to musculoskeletal injuries due to increased catabolic pathway signaling, i.e. protein degradation and decreased anabolic pathway signaling, compromising muscle integrity. In this sense, we indicate the relationship between musculoskeletal injuries and sleep debt involving new targets for immunological signaling pathways that start the reduction of the muscle recovery process.

Sleep and Athletic Performance: Impacts on Physical Performance, Mental Performance, Injury Risk and Recovery, and Mental Health

Research has characterized the sleep of elite athletes and attempted to identify factors associated with athletic performance, cognition, health, and mental well-being. Sleep is a fundamental component of performance optimization among elite athletes, yet only recently embraced by sport organizations as an important part of training and recovery. Sleep plays a crucial role in physical and cognitive performance and is an important factor in reducing risk of injury. This article aims to highlight the prevalence of poor sleep, describe its impacts, and address the issue of sport culture surrounding healthy sleep.

Effects of total sleep deprivation on endurance cycling performance and heart rate indices used for monitoring athlete readiness

This study investigated effects of total sleep deprivation on self-paced endurance performance, and heart rate (HR) indices of athletes' "readiness to perform". Endurance athletes (n = 13) completed a crossover experiment comprising a normal sleep (NS) and sleep deprivation (SD) condition. Each required completion of an endurance time-trial (TT) on consecutive days (D1, D2) separated by normal sleep or total sleep deprivation. Finishing time, perceived exertion (RPE), mood, psychomotor vigilance (PVT), and HR responses were assessed. Time on D2 of SD was 10% slower than D2 of NS (64 ± 7 vs 59 ± 4 min, P < 0.01), and 11% slower than D1 of SD (58 ± 5 min, P < 0.01). Subjective to objective (RPE:mean HR) intensity ratio was higher on D2 of SD compared with D2 of NS and D1 of SD (P < 0.01). Mood disturbance and PVT mean response time increased on D2 of SD compared with D2 of NS and D1 of SD. Anaerobic threshold and change in TT time were correlated (R = -0.73, P < 0.01). Sleep helps to optimise endurance performance. Subjective to objective intensity ratios appear sensitive to effects of sleep on athletes' readiness. Research examining more subtle sleep manipulation is required.

Sleep Hygiene for Optimizing Recovery in Athletes: Review and Recommendations

For elite athletes who exercise at a high level, sleep is critical to overall health. Many studies have documented the effects of sleep deprivation in the general population, but few studies exist regarding specific effects in the athlete. This review summarizes the effects of sleep deprivation and sleep extension on athletic performance, including reaction time, accuracy, strength and endurance, and cognitive function. There are clear negative effects of sleep deprivation on performance, including reaction time, accuracy, vigor, submaximal strength, and endurance. Cognitive functions such as judgment and decision-making also suffer. Sleep extension can positively affect reaction times, mood, sprint times, tennis serve accuracy, swim turns, kick stroke efficiency, and increased free throw and 3-point accuracy. Banking sleep (sleep extension prior to night of intentional sleep deprivation before sporting event) is a new concept that may also improve performance. For sports medicine providers, the negative effects of sleep deprivation cannot be overstated to athletes. To battle sleep deprivation, athletes may seek supplements with potentially serious side effects; improving sleep quality however is simple and effective, benefiting not only athlete health but also athletic performance.

One night of sleep restriction following heavy exercise impairs 3-km cycling time-trial performance in the morning

The goal of this project was to examine the influence of a single night of sleep restriction following heavy exercise on cycling time-trial (TT) performance and skeletal muscle function in the morning. Seven recreational cyclists (age, 24 ± 7 years; peak oxygen consumption, 62 ± 4 mL·kg−1·min−1) completed 2 phases, each comprising evening (EX1) and next-morning (EX2) exercise sessions. EX1 and EX2 were separated by an assigned sleep condition: a full night of rest (CON; 7.1 ± 0.3 h of sleep) or sleep restriction through early waking (SR; 2.4 ± 0.2 h). EX1 comprised baseline testing (muscle soreness, isokinetic torque, and 3-km TT performance) followed by heavy exercise that included 60 min of high-intensity cycling intervals and resistance exercise. EX2 was performed to assess recovery from EX1 and included all baseline measures. Magnitude-based inferences were used to evaluate all variables. SR had a negative effect (very likely) on the change in 3-km TT performance compared with CON. Specifically, 3-km TT performance was ‘very likely’ slower during EX2 compared with EX1 following SR (−4.0% ± 3.0%), whereas 3-km TT performance was ‘possibly’ slower during EX2 (vs. EX1) following CON (−0.5% ± 3.0%). Sleep condition did not influence changes in peak torque or muscle soreness from EX1 to EX2. A single night of sleep restriction following heavy exercise had marked consequences on 3-km TT performance the next morning. Because occasional sleep loss is likely, strategies to ameliorate the consequences of sleep loss on performance should be investigated.

Does one night of partial sleep deprivation affect the evening performance during intermittent exercise in Taekwondo players?

Athletes and coaches believe that adequate sleep is essential for peak performance. There is ample scientific evidence which support the conclusion that sleep loss seems to stress many physiological functions in humans. The aim of this study was to determine the effect of one night’s sleep deprivation on intermittent exercise performance in the evening of the following day. Ten male Taekwondo players performed the Yo-Yo intermittent recovery test (YYIRT) in three sleep conditions (reference sleep night [RN], partial sleep deprivation at the beginning of night [PSDBN], partial sleep deprivation at the end of night [PSDEN]) in a counterbalanced order, allowing a recovery period ≥36 hr in between them. Heart rate peak (HRpeak), plasma lactate concentrations (Lac) and rating of perceived exertion (RPE) were measured during the test. A significant effect of sleep restriction was observed on the total distance covered in YYIRT (P<0.0005) and Lac (P<0.01) in comparison with the RN. In addition, performance more decreased after PSDEN (P<0.0005) than PSDBN (P<0.05). Also, Lac decreased significantly only after PS-DEN (P<0.05) compared with RN. However, there were no significant changes in HRpeak and RPE after the two types of partial sleep deprivation compared to RN. The present study indicates that short-term sleep restriction affect the intermittent performance, as well as the Lac levels of the Taekwondo players in the evening of the following day, without alteration of HRpeak and RPE.

Sleep and athletic performance: the effects of sleep loss on exercise performance, and physiological and cognitive responses to exercise

Although its true function remains unclear, sleep is considered critical to human physiological and cognitive function. Equally, since sleep loss is a common occurrence prior to competition in athletes, this could significantly impact upon their athletic performance. Much of the previous research has reported that exercise performance is negatively affected following sleep loss; however, conflicting findings mean that the extent, influence, and mechanisms of sleep loss affecting exercise performance remain uncertain. For instance, research indicates some maximal physical efforts and gross motor performances can be maintained. In comparison, the few published studies investigating the effect of sleep loss on performance in athletes report a reduction in sport-specific performance. The effects of sleep loss on physiological responses to exercise also remain equivocal; however, it appears a reduction in sleep quality and quantity could result in an autonomic nervous system imbalance, simulating symptoms of the overtraining syndrome. Additionally, increases in pro-inflammatory cytokines following sleep loss could promote immune system dysfunction. Of further concern, numerous studies investigating the effects of sleep loss on cognitive function report slower and less accurate cognitive performance. Based on this context, this review aims to evaluate the importance and prevalence of sleep in athletes and summarises the effects of sleep loss (restriction and deprivation) on exercise performance, and physiological and cognitive responses to exercise. Given the equivocal understanding of sleep and athletic performance outcomes, further research and consideration is required to obtain a greater knowledge of the interaction between sleep and performance.

Exercise-Induced growth hormone during acute sleep deprivation

The effect of acute (24‐h) sleep deprivation on exercise‐induced growth hormone (GH) and insulin‐like growth factor‐1 (IGF‐1) was examined. Ten men (20.6 ± 1.4 years) completed two randomized 24‐h sessions including a brief, high‐intensity exercise bout following either a night of sleep (SLEEP) or (24‐h) sleep deprivation (SLD). Anaerobic performance (mean power [MP], peak power [PP], minimum power [MinP], time to peak power [TTPP], fatigue index, [FI]) and total work per sprint [TWPS]) was determined from four maximal 30‐sec Wingate sprints on a cycle ergometer. Self‐reported sleep 7 days prior to each session was similar between SLEEP and SLD sessions (7.92 ± 0.33 vs. 7.98 ± 0.39 h, P =0.656, respectively) and during the actual SLEEP session in the lab, the total amount of sleep was similar to the 7 days leading up to the lab session (7.72 ± 0.14 h vs. 7.92 ± 0.33 h, respectively) (P =0.166). No differences existed in MP, PP, MinP, TTPP, FI, TWPS, resting GH concentrations, time to reach exercise‐induced peak GH concentration (TTP), or free IGF‐1 between sessions. GH area under the curve (AUC) (825.0 ± 199.8 vs. 2212.9 ± 441.9 μg/L*min, P <0.01), exercise‐induced peak GH concentration (17.8 ± 3.7 vs. 39.6 ± 7.1 μg/L, P <0.01) and ΔGH (peak GH – resting GH) (17.2 ± 3.7 vs. 38.2 ± 7.3 μg/L, P <0.01) were significantly lower during the SLEEP versus SLD session. Our results indicate that the exercise‐induced GH response was significantly augmented in sleep‐deprived individuals.

Human growth hormone release is heavily influenced by sleep and exercise. Our study shows that sleep deprivation dramatically augments the exercise‐induced human growth hormone response.

Effects of partial sleep deprivation on proinflammatory cytokines, growth hormone, and steroid hormone concentrations during repeated brief sprint interval exercise

The purpose of this study was to evaluate the effects of partial sleep deprivation (PSD) on circulating concentrations of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) in relation to the secretory profiles of growth hormone (GH), cortisol, and testosterone during a repeated brief sprint interval exercise. Thirty healthy football players (mean age: 21.1 [range: 18-24] years; body mass index [BMI]: 22.6 [range: 18.47-24.46] Kg/m(2)) completed two test sessions at 08:00 h, one scheduled after a baseline night (bedtime: from 22:30 to 07:00 h) and the other after a PSD night caused by an early awakening (bedtime: from 22:30 to 03:00 h). During each session, participants performed 4 × 250-m run on a treadmill at a constant intensity of 80% of the personal maximal speed with a 3-min recovery in between. Tests session were performed at 08:00 h. Blood samples were collected before, immediately after the first and the fourth 250-m run, and 60 min after the exercise. The results showed that cortisol concentrations were not affected by the PSD. However, GH and testosterone concentrations were higher (p < .05) 60 min after the exercise during PSD in comparison with baseline. Likewise, plasma concentrations of IL-6 and TNF-α were higher (p < .05) after PSD during the exercise (i.e., the first and the fourth run) and remained elevated during the recovery period (i.e., 60 min after the exercise). In conclusion, these results showed that sleep restriction increases the proinflammatory cytokine, GH, and testosterone concentrations after physical exercise but did not affect the cortisol responses.

Sleep in athletes and the effects of Ramadan

Sleep is now considered as a new frontier in performance enhancement. This article presents background content on sleep function, sleep needs and methods of sleep investigation along with data on the potential effects of Ramadan fasting on sleep in normal individuals and athletes. Accumulated sleep loss has negative impacts on cognitive function, mood, daytime sleepiness and performance. Sleep studies in athletes fasting during Ramadan are very rare. Most of them have demonstrated that during this month, sleep duration decreased and sleep timing shifted. But the direct relation between sleep changes and performance during Ramadan is not yet elucidated. Objective sleep patterns can be investigated using polysomnography, actigraphy, and standardised questionnaires and recorded in daily journals or sleep logs. The available data on sleep indicate that team doctors and coaches should consider planning sleep schedule and napping; implementing educational programmes focusing on the need for healthy sleep; and consider routine screening for sleep loss in athletes of all age groups and genders.

Pharmacogenetic studies of change in cortisol on ecstasy (MDMA) consumption

In this study we investigate the association of cytochrome P450 enzyme CYP2D6, catechol-O-methyl transferase (COMT, Val158Met) and serotonin transporter promoter (5-HTTLPR) genotypes on change in cortisol concentration following 3, 4-methylenedioxy-methamphetamine (MDMA, 'ecstasy') consumption. Forty-eight subjects (30 males, mean age 23 years), self-nominating regular clubbers provided 'in the field' pre- and post-clubbing biological samples and associated information. Of the 39 subjects who provided a post-clubbing urine sample, 21 were positive for MDMA. Plasma cortisol concentrations increased in subjects (n = 48) tested for cortisol, with changes being significantly greater in the MDMA-positive group (736.9 ± 83.2 vs. 350.9 ± 34.5 mmol/l, p = 0.001). We found a positive association between the low activity COMT genotype (Met/Met) and MDMA-induced change in cortisol and also between this and change in cortisol in the whole sample (p = 0.039, Bonferroni corrected). For CYP2D6, there was an association between genotype and change in cortisol, confined to subjects with MDMA-positive urine post-clubbing (p = 0.003, Bonferroni corrected). There was no association with 5-HTTLPR genotype. These associations suggest that chronic use of MDMA may lead to HPA axis dysregulation and that the magnitude of this may be moderated by genetic polymorphism, and warrant further investigation in a larger sample of those who consume the drug on a regular basis.

Intermittent-sprint performance and muscle glycogen after 30 h of sleep deprivation

PURPOSE

The aim of this study was to determine the effects of 30 h of sleep deprivation on consecutive-day intermittent-sprint performance and muscle glycogen content.

METHODS

Ten male, team-sport athletes performed a single-day "baseline" session and two consecutive-day experimental trials separated either by a normal night's sleep (CONT1 and CONT2) or no sleep (SDEP1 and SDEP2). Each session included a 30-min graded exercise run and 50-min intermittent-sprint exercise protocol, including a 15-m maximal sprint every minute and self-paced exercise bouts of varying intensities. Muscle biopsies were extracted before and after exercise during the baseline session and before exercise on day 2 during experimental trials. Voluntary force and activation of the right quadriceps, nude mass, HR, core temperature, capillary blood lactate and glucose, RPE, and a modified POMS were recorded before, after, and during the exercise protocols.

RESULTS

Mean sprint times were slower on SDEP2 (2.78±0.17 s) compared with SDEP1 (2.70±0.16 s) and CONT2 (2.74±0.15 s, P<0.05). Distance covered during self-paced exercise was reduced during SDEP2 during the initial 10 min compared with SDEP1 and during the final 10 min compared with CONT2 (P<0.05). Muscle glycogen concentration was lower before exercise on SDEP2 (209±60 mmol·kg dry weight) compared with CONT2 (274±54 mmol·kg dry weight, P=0.05). Voluntary force and activation were reduced on day 2 of both conditions; however, both were lower in SDEP2 compared with CONT2 (P<0.05). Sleep loss did not affect RPE but negatively affected POMS ratings (P<0.05).

CONCLUSIONS

Sleep loss and associated reductions in muscle glycogen and perceptual stress reduced sprint performance and slowed pacing strategies during intermittent-sprint exercise for male team-sport athletes.

Sport psychiatry: a systematic review of diagnosis and medical treatment of mental illness in athletes

Sport psychiatry focuses on diagnosis and treatment of psychiatric illness in athletes in addition to utilization of psychological approaches to enhance performance. As this field and its research base are relatively new, clinicians often deliver psychiatric care to athletes without a full understanding of the diagnostic and therapeutic issues unique to this population. In this systematic review, we discuss published findings relating to psychiatric diagnosis and medical treatment of mental illness in athletes. There have been several studies looking at the prevalence of some psychiatric disorders in various athlete populations. Eating disorders and substance abuse are the most studied of these disorders and appear to be common problems in athletes. However, to provide informed understanding and treatment, we especially need more research on overtraining syndrome, bipolar disorder, suicidality, anxiety disorders, attention-deficit hyperactivity disorder (ADHD) and psychosis in athletes. Research is needed in the areas of prevalence, risk factors, prognosis and the unique experiences facing athletes with any of these disorders. Additionally, there have not been any large, systematic studies on the use of psychotropic medications in athletes. Small studies suggest that some medications may either be performance enhancing or detrimental to performance, but we need larger studies with rigorous methodology. Higher level athletes suffering from psychiatric symptoms often have reservations about taking medications with unknown performance and safety effects, and methodological issues with the current literature database preclude any definitive conclusions on performance effects of psychiatric medications. We need many more, higher quality studies on the use by athletes of antidepressants, mood stabilizers, anxiolytics, stimulants and other ADHD medications, sedative-hypnotics and antipsychotics. Such studies should utilize sensitive performance measures and involve longer term use of psychotropic medications. Furthermore, study subjects should include athletes who actually have the psychiatric disorder for which the medication is proposed, and should include more women.

Disrupted sleep the night before breast surgery is associated with increased postoperative pain

Despite the best available clinical care, pain after surgery is a virtually universal patient experience that can have pervasive negative consequences. Given the large variability among patients in postoperative pain levels, research on novel modifiable risk factors is needed. One such factor suggested by recent experimental studies indicates that disruption of even a single night's sleep can increase subsequent pain in healthy volunteers. In this preliminary clinical study, we tested the hypothesis that poor sleep the night before surgery would predict heightened postoperative pain. Patients (n=24) scheduled for routine breast-conserving surgical procedures for the diagnosis or treatment of cancer were recruited and wore an actigraphy device providing objective, validated measures of sleep duration and disruption (low sleep efficiency). Pain severity and interference with daily activities for the week after surgery was assessed with the Brief Pain Inventory. As hypothesized, multiple regression analyses revealed that lower sleep efficiency was a significant predictor of greater pain severity and interference, controlling for age, race, and perioperative analgesics as appropriate. Sleep efficiency was not significantly related to measures of depressed mood, emotional upset, or relaxation assessed on the morning of surgery. Patients with sleep efficiency in the lowest tertile had clinically higher levels of pain (>2 points) compared with patients in the highest sleep efficiency tertile. Sleep duration had no significant effects. This preliminary clinical study supports the possibility that sleep disruption on the night before surgery may increase patients' experience of pain after surgery. Research to investigate the mechanisms underlying these effects and to explore the possible clinical benefits of interventions to improve patients' sleep before surgery is now warranted.

Sleep management and the performance of eight sailors in the Tour de France à la voile yacht race

We observed how sailors manage their sleep and alertness before and during competition in a long-haul yacht race. Global performance of the teams was also recorded. We assessed eight sailors aged 21-30 years, split into four teams, who competed in the Tour de France à la Voile 2002 yacht race. Two phases of the race were examined: two legs in both the Atlantic Ocean and Mediterranean Sea. Sleep length, sleep debt, and sleepiness before competition and on board during the race were assessed using ambulatory polysomnography. Intermediate and final rankings were considered as a reflection of performance. A significant correlation was observed between the sleep debt before competition and the total sleep time on board during the Atlantic legs. The greater the sleep debt, the more sleepy the participants were. During the Mediterranean legs, almost all the sailors were deprived of sleep and slept during the daytime competitions. We observed that the final ranking in the race related to the sleep management strategy of the participants. In extreme competitive conditions, the effect of a good night's sleep before competition on performance is important. The strategy of the winners was to get sufficient sleep before each leg so as to be the most alert and efficient during the race.

Poor sleep the night before an experimental stressor predicts reduced NK cell mobilization and slowed recovery in healthy women

Sleep is important for health; however, poor sleep is a growing problem in many Western societies, particularly among women. Alterations in immune function following poor sleep (defined by duration and disruption) may be linked to ill health. Not yet investigated are the possible effects on stress-induced mobilization of lymphocytes. As natural killer (NK) cells are particularly responsive to acute stress, the present study examined whether sleep period duration and percentage of time awake after sleep onset (WASO) the night before a laboratory stressor would predict reduced NK cell mobilization. Sleep was monitored by actigraphy in 39 healthy women. NK cell peripheral blood numbers were determined at baseline (post-20 min rest), 4 min into a Stroop task, immediately post-task and 30 min after task completion. Participants with high WASO had significantly less NK cell mobilization to the stressor and failed to return to baseline levels after 30 min compared to women with low WASO. No effects were found for sleep period duration. Findings raise the possibility that inadequate NK cell mobilization to, and poor recovery from acute stress may be one pathway by which sleep could impact health.

Insomnia: pathophysiology and implications for treatment

Interest in developing a greater understanding of the pathophysiogical mechanisms underlying primary insomnia has increased. Recent evidence indicates that there may be some neuroendocrine and clinical similarities between primary insomnia and major depressive disorder, that abnormal corticotropin releasing factor (CRF) activity occurs in major depression, and that CRF hyperactivity appears to mediate the hyperarousal seen in primary insomnia. These findings all point to the possibility of hypothalamic-pituitary-adrenal (HPA) axis and CRF overactivity in both disorders. More recent findings have strengthened the evidence that primary insomnia may be linked with mood disorders and is associated with HPA axis overactivity and excess secretion of CRF, adrenocorticotropin releasing hormone, and cortisol. These insights have implications for managing chronic primary insomnia, such as use of antiglucocorticoid agents.

The sleep-wake cycle and sleeping pills

Sleeping pills are drugs which are used world-wide to combat sleep disturbances, and to prevent symptoms due to maladjustment to shiftwork or jet-lag. Today, benzodiazepines and the so-called "non-benzodiazepines", such as zolpidem, which both act on benzodiazepine receptors, are drugs of first choice and they are substitutes for barbiturates. Their use as sleeping pills in insomniacs is established after appropriate medical diagnosis. Symptoms from shiftwork or jet-lag are due to an internal desynchronisation of biological rhythms, and there is ample evidence that benzodiazepines are not effective in preventing these symptoms. Cabin crews in particular should never take sleeping pills, in order not to impair cognitive functions or to reduce the reactivity needed to fly an aircraft safely. The biological clock(s) cannot be reset instantaneously by any drug.